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    Contact Us

    Immunization Branch
    Central Office
    1100 West 49th Street
    Austin, Texas 78756

    Phone: (512) 776-3711
    Fax: (512) 458-7288

    TVFC Provider Enrollment Fax: (512) 776-7743

Focused Administration of Vaccine and Prophylactic Medications [ Page 10 ]

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Immunization Branch

logo: Vaccines Build your child's health

TRAINING GUIDES

CDC Resources for Smallpox

Link to domain outside of TDH. Smallpox Information for Specific Groups

Link to domain outside of TDH. Vaccinia (Smallpox) Vaccine Recommendations

FORMS AND DOCUMENTATION

Biological Order and Transfer Form (C-68)PDF Icon (76KB)—Used to order and transfer vaccine. Used as needed by clinics and depots.

Texas DSHS Monthly Biological Report (C-33A)—Used to record vaccine inventory by lot number for each storage site or depot. Submitted monthly to BIP.

Texas DSHS Daily Tally Sheet (C-88)PDF Icon (19KB)—Used to record doses administered by age for each clinic site. Submitted after completion of clinic to centralized supply depot or immunization program.

Texas DSHS Doses Administered (C-5)PDF Icon (11KB)—Used to report doses administered by age for jurisdiction or public health region. Submitted monthly to BIP.

To order or print TDH forms go to: http://www.tdh.state.tx.us/immunize/doseform.htm

TDH Personal Immunization Records (C-102 and C-100 for child; C-104 for adults)—Client's personal record of vaccines they received at clinics.

Link to domain outside of TDH.VAERS (Vaccine Adverse Event Reporting System) FormPDF Icon (20KB)

Clinic Registration SheetPDF Icon (8KB)

Screening Tool for Smallpox

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Last updated July 13, 2012